Project Summary/Abstract Integrative medicine is, by definition, designed to combine mainstream scientific medical care with the best of practices that have been demonstrated to enhance our ability to prevent or live better with illness. Both rTMS and hypnosis have proven ability to reduce pain. Our aim is to integrate recent functional imaging data regarding hypnosis with that associated with the neural effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of fibromyalgia. Fibromyalgia is a poorly understood but common disorder characterized by the combination of widespread pain, fatigue, and sleep disruption. Our plan is to understand the brain mechanism of augmenting hypnosis and hypnotic analgesia with rTMS. We propose to identify 90 moderately hypnotizable subjects with fibromyalgia syndrome and measure their response to hypnosis, standardized pain stimuli and rTMS in the fMRI scanner before and during rTMS- augmented hypnosis and hypnotic analgesia. We will randomly assign subjects to receive either active DLPFC rTMS or sham rTMS augmentation so that we can compare results. We will have two scan sessions for each subject, one in which they receive hypnosis session where they receive control scan, control scan + hypnosis, rTMS, control scan + rTMS, and rTMS-augmented hypnosis and the other is the hypnotic analgesia session where the participant receives control scan, control scan + pain thresholds, rTMS, post rTMS scan, and rTMS-augmented hypnotic analgesia. We have three specific aims: 1) Understand the effect and neural basis of rTMS-augmentation of hypnotizability; 2) understand the effect of rTMS on hypnotizability and depth of hypnosis; 3) understand the effect and brain basis of combining hypnotic analgesia with rTMS, and 4) compare the condition of stimulation (active versus sham) with the subjective pain reduction. This approach will establish both common ground and differences between hypnotic and neuromodulatory pain relief and the potential for combining these two approaches, thereby integrating traditional and modern biomedical means of effectively treating pain. The goal is to provide a scientific basis for augmenting both approaches by combining them, thereby providing better analgesia with fewer side effects, while enhancing the ability to manage pain.